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Position Statement: Cardiopulmonary Resuscitation of Patients with Confirmed or Suspected COVID-19 - 2020
Hélio Penna Guimarães1, Sérgio Timerman2, Roseny Dos Reis Rodrigues1
1Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.
Insights
During the COVID-19 pandemic, cardiac arrest care requires specific protocols. Recommendations emphasize aerosol precautions, early airway management, and HEPA filters for patient and staff safety.
Area of Science:
- Emergency Medicine
- Cardiology
- Critical Care
- Anesthesiology
Background:
- COVID-19 pandemic presents unique challenges for cardiac arrest management.
- Limited robust evidence necessitates updated guidelines for healthcare workers.
- Protecting both healthcare professionals and patients is paramount during resuscitation efforts.
Purpose of the Study:
- To provide joint recommendations for cardiac arrest care during the COVID-19 pandemic.
- To guide healthcare workers in implementing safety measures and specific interventions.
- To address unique aspects of cardiac arrest in COVID-19 patients, balancing standard protocols with pandemic-specific needs.
Main Methods:
- Development of a joint position statement by leading Brazilian medical societies.
- Inclusion of recommendations for personal protective equipment and aerosol precautions.
- Emphasis on addressing specific cardiac arrest causes relevant to COVID-19, such as hypoxia and myocarditis.
Main Results:
- Mandatory use of full aerosol precautions, including appropriate personal protective equipment.
- Recommendations for early invasive airway device placement and HEPA filter use.
- Specific guidance on ventilator settings and rescuer positioning for cardiac arrest during mechanical ventilation or prone positioning.
Conclusions:
- Adherence to aerosol precautions and HEPA filter use is critical during cardiac arrest resuscitation in the COVID-19 era.
- Early recognition and management of COVID-19-specific cardiac arrest etiologies are essential.
- Modified resuscitation techniques may be required, while otherwise adhering to established national and international guidelines.
Abstract:
Care for patients with cardiac arrest in the context of the coronavirus disease 2019 (COVID-19) pandemic has several unique aspects that warrant particular attention. This joint position statement by the Brazilian Association of Emergency Medicine (ABRAMEDE), Brazilian Society of Cardiology (SBC), Brazilian Association of Intensive Care Medicine (AMIB), and Brazilian Society of Anesthesiology (SBA), all official societies representing the corresponding medical specialties affiliated with the Brazilian Medical Association (AMB), provides recommendations to guide health care workers in the current context of limited robust evidence, aiming to maximize the protection of staff and patients alike. It is essential that full aerosol precautions, which include wearing appropriate personal protective equipment, be followed during resuscitation. It is also imperative that potential causes of cardiac arrest of particular interest in this patient population, especially hypoxia, cardiac arrhythmias associated with QT prolongation, and myocarditis, be considered and addressed. An advanced invasive airway device should be placed early. Use of HEPA filters at the bag-valve interface is mandatory. Management of cardiac arrest occurring during mechanical ventilation or during prone positioning demands particular ventilator settings and rescuer positioning for chest compressions which deviate from standard cardiopulmonary resuscitation techniques. Apart from these logistical issues, care should otherwise follow national and international protocols and guidelines, namely the 2015 International Liaison Committee on Resuscitation (ILCOR) and 2019 American Heart Association (AHA) guidelines and the 2019 Update to the Brazilian Society of Cardiology Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guideline.
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